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General NPI Number Information
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NPI Number | 1548626807
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Entity Type | Organization
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Legal Business Name | DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.
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Dates
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Enumeration Date | 01/01/2016
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Last Update Date | 01/01/2016
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Provider Practice Location Address
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Address Line | 10900 183RD ST SUITE 105
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City | CERRITOS
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State | CA
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Zip | 90703-5342
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Country | US
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Telephone | 323-854-6284
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Fax | 562-219-5013
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Provider Business Mailing Address
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Address Line | PO BOX 2619
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City | GARDENA
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State | CA
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Zip | 90247-0619
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Country | US
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Telephone | 323-422-7138
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Fax | 323-777-6674
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Authorized Official
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Title or Position | PSYCHOLOGICAL ASSISTANT
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Name | DR. ALPHONSO DAVIS
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Credential | PSY.D.,, M.A., PPS
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Telephone | 323-422-7138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSB94021086
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License Number State | CA
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